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Opportunities to Reduce Oral Health Disparities: Basic Sciences to Clinical Practice Peter Milgrom, DDS University of Southern California, February 2003

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Opportunities to Reduce Oral Health Disparities: Basic Sciences to Clinical Practice Peter Milgrom, DDS University of Southern California, February 2003. University of Washington Northwest/Alaska Center for Research to Reduce Oral Health Disparities.

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slide1

Opportunities to Reduce Oral Health Disparities: Basic Sciences to Clinical Practice

Peter Milgrom, DDS

University of Southern California, February 2003

university of washington northwest alaska center for research to reduce oral health disparities
University of Washington Northwest/Alaska Center for Research to Reduce Oral Health Disparities
beta defensins in caries prone children goals
This project is designed to study a biological marker that may influence susceptibility to tooth decayBeta-Defensins in Caries-Prone Children Goals

Dental Health

Oral hygiene

Diet

Host Defense

The oral soft tissue and saliva make defenses against bacteria.

These defenses include beta-defensins,natural antibiotics.

We believe that these beta-defensins help to prevent dental caries.

people
Beverly A. Dale-Crunk, PhD

Richard Jurevic, DDS

Norma Wells, RDH, MPH

Marjorie Tsutsui, Dental Stud

Nancy Chino, Science Stud

Peggy Chrisman, UW Res Tech

Kimberly Matteiu, BS, RDH

Oscar Suarez, DDS

People
more people
Eileen Beiersdorf, Superintendent, Toppenish School

Leonor de Maldonado, Principal, Toppenish Middle School

Susan Vlahakis, RN special education

Pat Brown, DSHS Children’s Program Manager and Yakima County Children’s Oral Health Coalition

James Falco, Dean, Arts & Sciences, Heritage College

Robert Ozuna, Director, UW-Yakima Valley Comm Partnerships, Heritage Center

Barbara Owens, Director Dental Admin. Services, YVFWC

Mark Koday, DDS, Dental Director, YVFWC

Cheryl Vyhmeister, Mobile Unit Coordinator, YVFWC

More People
slide6

GM

Tooth

JE

Oral hygiene

Defensins

Bacteria

Tooth Decay

Diet

Defensins are natural antibiotic peptides

- and we make them !!!

They are inherited like hair color and height.

slide7
Our study explores possible links between beta-defensins and dental caries in children.

Is there a difference in children with low and high dental decay?

Measure the amount of beta-defensins in saliva

Look at genetic differences

Subject Population

We chose Toppenish for our study because of the history of the University of Washington Dental School in promoting oral health in the Yakima Valley area, because of the location near Heritage College, a partner in education and research, and because of the YVFWC.

time line
Hum subjects, fall 01

Meet with Toppenish school and community group representatives 2/02

Meet with parents and children - educational presentation 5/02

Time Line
snps are genetic differences that we can assay
SNPs are genetic differences that we can assay

We have found single base pair changes in the genes for beta-defensins.

These changes, called single nucleotide polymorphisms (SNPs) are a very common type of genetic variation. SNPs can be silent, deleterious, or even advantageous.

Preliminary data shows a possible protective effect of one SNP (-44).

demographics
Demographics
  • 149 subjects; 88 females 61 males
  • Mainly Hispanic (127), Native American (5), Caucasian (16), African Amer. (1)
  • Age (range 11-15)
  • Most had permanent dentition
    • mixed dentition (20%), missing teeth (6%), loose teeth (11%)
hbd 1 snp 44 analysis and caries experience
hBD-1 SNP (-44) analysis and caries experience

Caries 0 Lo Hi

Number 50 47 47

SNP -44 0.40 0.47 0.53

There is not an association of this hBD-1 SNP with caries experience. Our findings did not support the trend of the pilot data.

additional work in progress
Additional Work in Progress
  • hBD-1 and hBD-2 SNP analysis
  • Bacterial load in saliva
  • hBD-2, and hBD-3 assay in saliva
  • Determine association of additional b-defensin SNPs with caries experience
  • Determine association of salivary bacterial load with defensin expression and caries experience
slide13

Sign up and

Be part of the Solution

benefits
Benefits
  • The potential long-term benefit is that simple, non-invasive procedures may be developed to help predict susceptibility to dental caries.
  • We hope to gain an understanding of the biological basis for susceptibility to caries.
  • Subjects in this study with severe dental problems will be referred to the Yakima Valley Farm Workers Clinic or other local providers for treatment.
slide16

OBJECTIVE To examine the usefulness of early orthodontic intervention as a means of increasing access to orthodontic services for children of low-income families

rationale
Rationale
  • Prevalent model for rationing orthodontic services for Medicaid patients
    • Minimal participation by dentists
    • Minimal access for clients
  • Potential advantages of interceptive / limited treatment
    • Potential for increased participation by dentists thereby increasing access
    • Potential for psychosocial benefits during development
    • Potential for reduced costs / client
  • Demonstration project at Odessa Brown Children’s Clinic serving low-income children in urban inner Seattle
specific aim 1
Specific Aim 1
  • To compare orthodontic outcomes, facial body image, and quality of life between Medicaid participants who receive early orthodontic TX and those who do not
  • To compare the level of understanding, compliance, and orthodontic outcomes between subjects given information about goals, risks, and benefits by an orthodontist with those who also use an interactive CD-ROM.
specific aim 2
Specific Aim 2
  • To compare orthodontic outcomes, facial body image, and quality of life between Medicaid-funded and private-pay patients who receive full orthodontic TX
specific aim 3
Specific Aim 3
  • To compare orthodontic outcomes, facial body image, and quality of life between Medicaid-funded patients who receive early orthodontic treatment only and Medicaid funded patients who receive full orthodontic treatment at adolescence
why do this
Why Do This?

Develop community-based research that translates existing knowledge and new information about children and their caretakers into new technologies and interventions that will reduce disparities

study design
Study Design
  • Component 1
    • Randomized Clinical Trial
    • Aim 1 - treatment vs no treatment in mixed dentition (ages 8-11)
    • Aim 3 - same subjects, with those not receiving early treatment receiving comprehensive treatment (ages 12 - 14)
  • Component 2
    • Cohort Study
    • Aim 2 - Medicaid-funded comprehensive treatment compared to private-pay comprehensive treatment
slide23

Observation

Early TX

(n=75)

AIM

1

AIM

3

Medicaid Patients

Observation

(n=75)

Full TX

AIM

2

Matched Private-Pay Patients

(n=65)

Full TX

slide24

CD-ROM

(n=30)

Standard

consult

(n=30)

AIM 1A

Early TX

(n=75)

Medicaid

Patients

Observation

(n=75)

Randomization

AIM 1

outcome variables
Outcome Variables
  • Dental Variables
    • Peer Assessment Rating (PAR) Index
    • Index of Complexity, Outcome, and Need (ICON)
  • Attitude and Behavior
    • Dental Background
    • Body Image
    • Quality of Life
xylitol clinical studies

2

0

Xylitol/clinical studies…

3

6

X

y

l

i

t

o

l

C

o

n

t

r

o

l

1

8

1

6

3

6

3

0

1

4

3

6

3

0

1

2

3

0

2

9

1

0

3

6

0

1

2

3

Years

B

a

s

e

l

i

n

e

F

i

n

a

l

e

r

xylitol clinical studies31
Xylitol/clinical studies…
  • Xylitol is most effective in caries prevention of erupting teeth (Ylivieska 1988, Belize 1996, Estonia 2000)
  • The ”therapeutic” effects of xylitol appear only in habitual use and with high enough frequencies/doses
  • Xylitol vehicles: chewing gum, lozenges, toothpaste (?)
mechanisms of action of xylitol
Mechanisms of action of xylitol
  • No acid production
  • Reduces plaque by suppressing formation of adhesive macromolecules, especially glucans
  • Selects for less adhesive mutans streptococci

Xylitol:C5

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